阿司匹林治疗儿童川崎病的机制

Mechanism of aspirin in the treatment of Kawasaki disease in children

目的探讨阿司匹林抑制血小板聚集和调节血管内皮功能治疗儿童川崎病(Kawasaki disease,KD)的机制。方法选取门诊儿童KD患儿68例,均采用阿司匹林治疗,根据治疗效果将患儿分为治疗有效组(n=51)和无效组(n=17),比较2组血小板聚集相关因子、代谢标志物和血管内皮因子的水平。结果2组的性别、年龄、体质量、身高、血压、心率和病程等一般资料比较差异均无统计学意义(P>0.05)。治疗6个月后,有效组的血小板(platelet,PLT)、红细胞沉降速率(erythrocyte sedimentation rate,ESR)和白细胞(white blood cell,WBC)的水平均明显低于无效组(P<0.05);2组的代谢标志物血糖(glucose,GLU)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)比较差异均无统计学意义(P>0.05);有效组的内皮一氧化氮合酶(endothelial nitric oxide synthase,eNOS)水平明显高于无效组,且血管内皮生长因子(vascular endothelial growth factor,VEGF)、内皮抑素(endostatin,ES)水平均明显低于无效组(P<0.05)。结论治疗有效KD患儿的PLT、ESR和WBC水平呈明显的下降趋势,阿司匹林可以抑制血小板聚集,改善血管内皮功能,不影响代谢标志物。

Objective To explore the mechanism of aspirin in the treatment of Kawasaki disease(KD)in children based on the inhibition of platelet aggregation and regulation of vascular endothelial function.Methods A total of 68 pediatric KD patients treated with aspirin were selected and divided into an effective group(n=51)and an ineffective group(n=17)according to the therapeutic effect.The levels of platelet aggregation related factors,metabolic markers and vascular endothelial factors were compared between the 2 groups.Results There was no significant difference in gender,age,weight,height,blood pressure,heart rate and the course of disease between the 2 groups(P>0.05).After 6 months of treatment,the levels of platelet(PLT),erythrocyte sedimentation rate(ESR)and white blood cell(WBC)in the effective group were significantly lower than those in the ineffective group(P<0.05).There was no significant difference in the metabolic markers of glucose(GLU),triglyceride(TG),total cholesterol(TC),high density lipoprotein(HDL)and low density lipoprotein(LDL)between the 2 groups(P>0.05).The level of endothelial nitric oxide synthase(eNOS)in the effective group was significantly higher than that in the ineffective group,and the vascular endothelial growth factor(VEGF)was also significantly higher.The levels of VEGF and endostatin(ES)were significantly lower than those of the ineffective group(P<0.05).Conclusion The levels of PLT,ESR and WBC in KD children with effective treatment tend to decrease,thus inhibiting platelet aggregation and improving endothelial function factors.No effect on metabolic markers has been found.